Adrenal Care
Secondary Hypertension Evaluation
Secondary hypertension is a type of high blood pressure that is caused by another health problem. This is different from the more common primary or essential hypertension, which has no clear underlying cause.
Secondary hypertension can be triggered by issues with the kidneys, arteries, heart, or hormone system. It can also occur during pregnancy. Treating the underlying health problem can often help control high blood pressure.
The primary treatment for secondary hypertension is to address the root cause of the high blood pressure. This may involve medications or even surgery in some cases. Once the underlying cause is treated, the high blood pressure may decrease on its own or return to normal levels.
Medications may still be needed to manage the blood pressure, even after the underlying condition is treated. Common blood pressure medications used include:
- Diuretics (water pills) to help the kidneys remove excess sodium and water
- Beta blockers may be used to reduce the burden on the heart
- ACE inhibitors and angiotensin receptor blockers to relax blood vessels
- Calcium channel blockers to help blood vessels relax
The specific medication(s) used will depend on the individual’s needs and the underlying health problem.
Treating secondary hypertension can be more complex than primary hypertension. Regular monitoring and adjustments to the treatment plan may be needed to effectively control the blood pressure and address the root cause.
Adrenal Mass Treatment
Benign adrenal tumours are non-cancerous growths that develop in the adrenal glands. The adrenal glands are small hormone-producing organs located on top of the kidneys. These glands play a crucial role in the endocrine system, which is responsible for regulating various bodily functions through the release of hormones.
Most benign adrenal tumours do not cause any symptoms and do not require treatment. However, in some cases, these tumours may produce excessive amounts of certain hormones, leading to potential health issues. Hormones from the cortex (outer layer) of the adrenal gland control metabolism, blood pressure, and physical characteristics like hair growth. Hormones from the medulla (inner layer) regulate the body’s response to stress.
Treatment for benign adrenal tumours depends on several factors, such as the likelihood of the tumour becoming cancerous and whether it is producing excess hormones. For smaller tumours, doctors recommend to wait and monitor the changes. This involves regular imaging tests and hormone level checks to monitor the tumour’s size and activity.
If the tumour is growing or causing symptoms, medications may be prescribed to manage the symptoms, such as high blood pressure. In some cases, surgery to remove the affected adrenal gland (adrenalectomy) may be necessary, especially if the tumour is large or likely to become cancerous. Laparoscopic surgery, a minimally invasive technique, may be an option for small tumours that are not suspected to be cancerous.
Regular check-ups and follow-up care are essential for individuals with benign adrenal tumours to ensure that the condition remains stable and to address any changes or complications that may arise.
Laparoscopic Suprarenal Mass Surgery
Adrenalectomy is a surgery to remove the adrenal gland when it is cancerous or producing too many hormones. This surgery can be done through small cuts (minimally invasive) or as an open surgery.
Laparoscopic adrenalectomy is a minimally invasive procedure. A tiny camera and small tools are inserted through these cuts. The surgeon can then completely remove the diseased adrenal gland. The gland is placed in a plastic bag and removed through one of the cuts.
This surgery is done under general anaesthesia and usually takes one to two hours. Patients who have laparoscopic adrenalectomy report less pain after surgery and faster recovery times compared to open surgery. They have less pain, a shorter hospital stay, and can return to work and daily activities sooner. The results are the same as open surgery for noncancerous tumours, and the scars are smaller.
Most patients recover quickly from laparoscopic adrenalectomy. They often stay in the hospital overnight and then recover at home for one to three weeks before returning to full activity.
Adrenal Cancer Treatment
Adrenal cancer is a rare type of cancer that starts in the small, triangular glands (adrenal glands) located on top of the kidneys. These glands play a crucial role in producing hormones that regulate various functions in the body.
When adrenal cancer is detected early, there is a better chance of successful treatment and potential cure. However, if the cancer has spread beyond the adrenal glands, the chances of a complete cure become lower. In such cases, treatment can be used to slow down the progression of the cancer or prevent it from coming back.
Adrenal cancer is primarily treated through surgery, during which doctors attempt to remove the entire affected adrenal gland (adrenalectomy). If the cancer has spread to nearby organs, such as the liver or kidney, the surgeon may also need to remove parts or all of those organs during the operation.
In some cases, when surgery is not an option, other treatments may be used to manage the cancer. These can include:
- Medications to control hormone production
- Radiation therapy might be used to target and completely destroy the cancer cells
- Chemotherapy to kill the cancer cells present throughout the entire body
The specific treatment plan will depend on the stage and characteristics of the adrenal cancer, as well as the individual patient’s overall health and preferences.
Retroperitoneoscopic Surgery
Minimally invasive adrenal surgery has become the preferred method for removing adrenal glands. There are two main minimally invasive approaches: transabdominal laparoscopic and posterior retroperitoneoscopic.
The transabdominal laparoscopic approach is a common choice as it allows the surgeon to have a familiar view and a large working space. This approach is suitable for adrenal tumours of various sizes, including larger ones and even some cancerous tumours, as long as they are less than 6 cm in size.
On the other hand, the posterior retroperitoneoscopic approach is particularly indicated for large, benign adrenal tumours that are producing hormones. This approach is faster and safer, especially for removing large pheochromocytomas (tumours that produce adrenaline). The retroperitoneoscopic method also results in shorter hospital stays, less postoperative pain, and faster recovery times compared to the transabdominal approach.
The choice between these two minimally invasive techniques ultimately lies with the operating surgeon. They will consider factors such as the size, type, and appearance of the adrenal tumour, as well as the patient’s medical history. If there are concerns about the tumour invading surrounding structures during the operation, the surgeon may decide to convert to an open surgical approach. Overall, both minimally invasive methods offer significant benefits over traditional open adrenal surgery.
Pancreas Surgery
A pancreatectomy is a surgical procedure that involves the removal of part or all of your pancreas. The pancreas is an essential organ in your digestive system, responsible for producing enzymes that help break down food and hormones that regulate your blood sugar levels.
The two most common reasons for a pancreatectomy are tumours and pancreatitis. Tumours in the pancreas can be a risk of spreading to other parts of your body, so removing them can help reduce this risk. Pancreatitis causes the pancreas to become inflamed, leading to severe pain and other complications. In severe cases, this may require removal of the pancreas.
During a pancreatectomy, the surgeon can remove different parts of the pancreas, depending on the specific condition. They may remove the tail, the body, or the entire pancreas. In some cases, the surgeon may also need to remove other nearby organs, such as the spleen, gallbladder, or part of the stomach.
The type of pancreatectomy performed will depend on the location and extent of the problem in your pancreas. For example, a distal pancreatectomy removes the tail of the pancreas, while a Whipple procedure removes the head of the pancreas, along with the duodenum and other nearby structures.
Regardless of the type of pancreatectomy, the goal is to remove the diseased or damaged part of the pancreas to improve your overall health and reduce the risk of further complications. After the surgery, you may need to take medication to help with digestion and maintain your blood sugar levels.
Thymus Surgery
The thymus gland is located in the upper chest, just behind the breastbone and in front of the heart. It is part of the immune system and plays a crucial role in a person’s early development. However, removing the thymus after birth does not affect the immune system.
Thymectomy, the surgical removal of the thymus, is recommended for certain patients to achieve various goals, such as:
- Reducing patient weakness
- Decreasing the need for medications
- Achieving long-term remission of the disease
Thymectomy is believed to help improve a patient’s condition in the long run.
There three main surgical approaches for thymectomy are:
- Trans-sternal: This frontal approach involves making an incision through the sternum to remove the thymus and surrounding fatty tissue. Sometimes, the neck area is also included to ensure complete removal of the thymus.
- DecreasingTranscervical: This horizontal approach is made through the lower neck and may extend to the chest to remove the fatty tissue around the thymus. the need for medications
- Videoscopic (VATS): This approach uses small incisions in the chest (right or left side) and thin, flexible tubes with cameras to guide the surgeon in removing the thymus and surrounding fatty tissue.
The trans-sternal approach is the most commonly used method for removing a thymoma.
After surgery, the patient may require a ventilator to assist with breathing. Once the breathing tube is removed, the patient will be encouraged to take deep breaths and cough to clear the lungs. Chest tubes may be used to drain excess fluid.
Pain levels vary depending on the surgical approach, with the trans-sternal approach causing more pain initially. However, pain can be managed with medication and usually resolves within a few days.
The length of hospital stay depends on the surgical approach and the patient’s overall health. Most patients are usually discharged within a few days to a week post surgery.
Neuroendocrine Tumour Treatment
Neuroendocrine tumours are a type of cancer that starts in special cells called neuroendocrine cells. These cells have features of both nerve cells and hormone-producing cells.
These tumours are not common and can develop anywhere in the body. Most often, they are found in the lungs, appendix, small intestine, rectum, and pancreas.
There are many different types of neuroendocrine tumours. Some grow slowly, while others grow quickly. Some release extra hormones (functional neuroendocrine tumours), while others don’t release enough hormones to cause symptoms (nonfunctional neuroendocrine tumours).
The treatment plan for your neuroendocrine tumour will depend on the type, location, and whether it’s causing hormone-related symptoms.
Common treatment options include:
- Surgery is used to remove the tumour and some healthy tissue from the surrounding area
- Chemotherapy using strong drugs to kill tumour cells
- Targeted drug therapy to block abnormalities in tumour cells
- Peptide receptor radionuclide therapy (PRRT) to deliver radiation directly to cancer cells
- Medications to control excess hormone levels
- Radiation therapy using powerful energy beams to kill tumour cells
The treatment aims to remove or shrink the tumour, control symptoms, and prevent the cancer from spreading to other organs or eventually coming back.
Obesity or Weight Loss Surgery
Bariatric surgery, also known as weight-loss or metabolic surgery, is a medical procedure that can help individuals who have struggled to lose weight through diet and exercise alone.
These surgeries work by making changes to your digestive system, either by limiting how much you can eat or reducing your body’s ability to absorb fat and calories.
While bariatric surgery is a major procedure with potential risks and side effects, it can offer significant benefits for those who are dealing with serious health problems due to their weight.
Some of the conditions that can be improved or even resolved through bariatric surgery include:
- Health Benefits of Bariatric Surgery
- Cancers, such as breast, endometrial, and prostate cancer
- Heart disease and stroke
- High blood pressure
- High cholesterol levels
- Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
- Sleep apnea
- Type 2 diabetes
Bariatric surgery is typically considered only after you have tried to lose weight through lifestyle changes, such as improving your diet and increasing your physical activity. It’s important to understand that successful long-term weight loss after surgery requires making permanent healthy changes to your eating habits and maintaining a regular exercise routine.
By having bariatric surgery and sticking to a healthier lifestyle, you can lose a lot of weight. This reduces your risk of potentially life-threatening weight-related health problems. It can improve your overall health and quality of life significantly.